Aphasia Therapy Video III

In this video, we watch a reading activity for aphasia language rehabilitation, employing Melodic Intonation Therapy (MIT) tapping and other strategies. The gentleman featured in this video reads sentences out loud with assistance from his clinician, which helps to relink neural connections from the written text (reading) to verbal output (speech). In a reading task such as the one featured here, several speech-language processes are engaged in the brain: letter recognition, letter-to-sound correspondence, motor planning to create those speech sounds, and auditory awareness to self-correct. (Reading comprehension is another activity targeted in speech therapy, although the focus in this video is to decode the written text into verbal output.) Any or all of these speech-language processes can be affected secondary to a stroke, traumatic brain injury, or other aphasia-causing condition.

During the reading activity, the clinician provides several speech therapy strategies (also called cues or prompts) to assist the gentleman in successfully reading the sentences out loud. He is able to read a full sentence out loud using a tactile tapping strategy, in which he “taps” with his left hand once for each syllable. The clinician to his left guides him hand-on-hand (HOH) to help him coordinate his tapping as he reads the target sentence out loud (“It’s the gift that keeps on giving”). Tapping is one of the main cues in the protocol of MIT, an intonation and rhythm-based treatment developed for individuals with nonfluent aphasia (Albert, Sparks, & Helm, 1973). Each syllable is tapped by the left hand, which is purported to engage right hemisphere activity to coordinate hand and mouth movements, as well as regulate the speaker’s speech pacing by breaking it down syllable-by-syllable.

Additional strategies that help with the reading activity in this video include direct models and phonemic cues. In the beginning of the video, the gentleman is instructed to look at the clinician as she provides a direct model of the target word “down.” This provides visual and auditory information for him to successfully repeat the target word. Later, the clinician provides phonemic cues as extra support, saying the first sound(s) of the target words: “It’s n__” for “It’s not” and “ou__” for “out.” The strategies described are tools the clinician provides to facilitate successful completion of an activity. As speech therapy continues to progress, these strategies or cues will be faded out towards independent usage of speech and language skills in activities of daily living.

Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared insights on how it is done and why it might help. The Neurosciences and Music III: Disorders and Plasticity: Annals of the New York Academy of Sciences, 1169, 431-436.